The national discussion of quality and patient safety has only recently begun to identify and understand the unique quality and patient safety issues facing rural hospitals, as opposed to those of their much larger and far more complex, urban counterparts. Serious questions arise about whether commonly proposed health information technology (HIT) interventions for quality and patient safety issues actually make sense in rural hospitals. Moreover, very few rural hospitals currently have the necessary HIT capacities because of expense, limited in-house HIT expertise, and mismatches among HIT applications. The project we propose is designed to meet the special needs of rural hospitals for assistance with planning HIT enhancements to address patient's safety and healthcare quality concerns. This project was developed in response to RFA HS-04-012 which states that "AHRQ is specifically interested in...applications that explore the unique barriers faced by rural and small community providers in adopting HIT and opportunities for overcoming these barriers" and "Research areas that are of particular interest to AHRQ include: development and evaluation of toolkits...that can be used by...decision-makers to help them understand the value of HIT and assist them to make HIT purchasing and implementation decisions." The proposed project has four primary objectives. First, we will document the patient safety and healthcare quality challenges unique to rural hospitals. Second, we will explore the current HIT capacity in rural hospitals, the potential use of HIT by rural hospitals to address their unique patient safety and healthcare quality issues, and the unique barriers faced by rural hospitals in adopting HIT. Third, we will measure value derived from HIT in rural hospitals and identify which HIT solutions for enhancing patient safety and healthcare quality have the greatest potential in terms of generating a positive return on investment. Fourth, we will create decision-making HIT toolkits to address barriers and provide solutions that are appropriate for rural hospitals. Once the toolkits are developed, we will make them available to rural hospital decision-makers. The toolkits will facilitate rural hospitals' ability to utilize current and emerging evidence to guide HIT investment and implementation decisions that fit their particular healthcare environment.